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Staff-led interventions for improving oral hygiene in patients following stroke

A clean mouth not only feels good but the practice of oral hygiene (removing dental plaque and traces of food) is a crucial factor in maintaining the health of the mouth, teeth and gums. A clean and healthy mouth will also prevent pain or discomfort and allow people to eat a range of nutritious foods. Maintaining good oral hygiene may be difficult after a stroke and healthcare staff may have to assist in providing such care. This review of three studies involving 470 participants found little evidence of how this care is best delivered. Information on a small number of nursing home residents who had a stroke (67 participants from a larger trial) showed that training nursing staff improved their knowledge of oral care and resulted in improved oral hygiene in their patients. Another trial demonstrated the beneficial impact of a decontamination gel on the incidence of pneumonia amongst patients in a stroke ward. However, there was no other information on how best to provide oral hygiene and more studies are urgently needed.

Authors' conclusions:

Based on two trials involving a small number of stroke survivors, OHC interventions can improve staff knowledge and attitudes, the cleanliness of patients' dentures and reduce the incidence of pneumonia. Improvements in the cleanliness of patients teeth were not observed. Further evidence relating to staff-led oral care interventions is severely lacking.

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Background:

For people with limitations due to neurological conditions such as stroke, the routine practice of oral health care (OHC) may become a challenge. Evidence-based supported oral care intervention is essential for this patient group.

Objectives:

To compare the effectiveness of staff-led OHC interventions with standard care for ensuring oral hygiene for individuals after a stroke.

Search strategy:

We searched the trials registers of the Cochrane Stroke Group (last searched April 2010) and Cochrane Oral Health Group (last searched May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library May 2010), MEDLINE (1966 to May 2010), CINAHL (1982 to May 2010), Research Findings Electronic Register (February 2006), National Research Register (Issue 1, 2006), ISI Science and Technology Proceedings (July 2010), Dissertation Abstracts and Conference Papers Index (August 2005), Zetoc (2000 to July 2010) and Proquest Dissertations and Theses (2000 to July 2010). We scanned reference lists from relevant papers and contacted authors and researchers in the field.

Selection criteria:

Randomised controlled trials that evaluated one or more interventions designed to improve oral hygiene. We included trials with a mixed population provided we could extract the stroke-specific data.

Data collection and analysis:

Two review authors independently classified trials according to the inclusion and exclusion criteria, assessed the trial quality and extracted data. We sought clarification from study authors when required.

Main results:

We included three studies involving 470 participants. These trials were of limited comparability evaluating an OHC education training programme, a decontamination gel and a ventilator-associated pneumonia bundle of care augmented with an OHC component by comparing them to a deferred intervention, a placebo gel or standard care respectively. The OHC educational intervention demonstrated a significant reduction in dentureplaque scores up to six months (P < 0.00001) after the intervention but not dental plaque. Staff knowledge (P = 0.0008) and attitudes (P = 0.0001) towards oral care also improved. The decontamination gel reduced the incidence of pneumonia amongst the intervention group (P = 0.03).

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